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. 2018 May;18(5):685-691.
doi: 10.1111/ggi.13226. Epub 2017 Dec 28.

Clusters of functional domains to identify older persons at risk of disability

Luisa Costanzo  1 , Claudio Pedone  1 , Matteo Cesari  2 , Luigi Ferrucci  3 , Stefania Bandinelli  4 , Raffaele Antonelli Incalzi  1
Affiliations

Clusters of functional domains to identify older persons at risk of disability

Luisa Costanzo et al. Geriatr Gerontol Int. 2018 May.

Abstract

Aim: To date, there is no consensus on which set of variables should be used to identify older persons at risk of disability in activities of daily living. The present study aimed to: (i) evaluate how different deficits cluster in a population of community-dwelling older persons; and (ii) investigate whether the discriminative capacity of physical performance measures towards the development of disability might be improved by adding psychological, social and environmental indicators.

Methods: Data are from 709 non-disabled older persons participating in the "Invecchiare in Chianti" study. We carried out a cluster analysis of 12 deficits in multiple functional domains, selected from the available frailty assessment instruments. Then, participants were assigned to a group, based on the obtained clusters of variables. For each group, we measured the prognostic capacity and the predictive ability for 6-year disability.

Results: The analysis showed a "physical" cluster (including weight loss, reduced grip strength/gait speed/physical activity, impaired balance, environmental barriers) and a "psychosocial" cluster (e.g. living alone, depression, low income). Thus, participants were classified into four groups according to the presence of a physical and/or psychosocial cluster. Compared with the "fit" group, the relative risks of becoming disabled in the "physical," "psychosocial" and "mixed" deficit groups were 2.23 (95% CI 0.71-7.00), 1.52 (95% CI 0.62-3.75) and 6.37 (95% CI 2.83-14.33), respectively. The positive and negative predictive values for the "physical," "psychosocial" and "mixed" deficit groups were, respectively, 9% and 87%, 6% and 83%, and 27% and 94%.

Conclusions: As expected, physical and psychosocial deficits cluster predominantly into different groups. Even when both are considered simultaneously, the ability to predict incident disability is still insufficient. Geriatr Gerontol Int 2018; 18: 685-691.

Keywords: cluster analysis; community-dwelling older persons; disability; frailty; predictive value.

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Conflict of interest statement

Disclosure statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Dendrogram resulting from cluster analysis testing the distribution of deficit indicators in the population.
See this image and copyright information in PMC

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